Provider Enrollment Revalidation
The Centers for Medicare & Medicaid Services (CMS) requires
state Medicaid programs to revalidate provider enrollments at
intervals not to exceed every five years. The CMS revalidation
requirement for durable medical equipment (DME) and home medical
equipment (HME) providers, including pharmacy providers with DME or
HME specialty enrollments, is more frequent, at intervals not to
exceed every three years.
Indiana Health Coverage Programs (IHCP) providers will receive
notification letters when it is time to revalidate their
enrollments. Notification with instructions for revalidating are
sent 90 and 60 days in advance of the revalidation deadline.
Notices are mailed to the Service Location address indicated
on the provider's service location profile. Providers with multiple
service locations must revalidate the enrollment of each service
location. Providers that fail to submit revalidation paperwork in a
timely manner will be disenrolled from participation in the IHCP as
of the revalidation due date indicated in the letter. After
disenrollment, the provider will need to submit a new
IHCP Provider Enrollment and Profile Maintenance
Packet to re-enroll with the IHCP. Disenrollment with
subsequent re-enrollment may result in a gap in the provider's
eligibility. Providers should not attempt to revalidate until they
receive their notification letter.
Provider Enrollment Revalidation Due Dates Through June
2017 to view a list of providers with upcoming
revalidation due dates.
Past-Due Revalidations and Provider Disenrollment
NOTE: Pursuant to federal regulations, all
providers enrolled with the IHCP before January 1, 2012, must
revalidate their enrollments by the deadline established
by the CMS. The CMS has directed states to disenroll any
provider that fails to revalidate. Affected providers that need to
revalidate their enrollments should have received notification
letters. Revalidation questions should be directed to Customer
Assistance at 1-800-577-1278
(select the Provider Enrollment prompt).
How to Revalidate an Enrollment
To revalidate an enrollment, providers must complete the
appropriate IHCP provider packet, the same as is required at
initial enrollment. There is not a separate revalidation
- To find the appropriate IHCP provider packet, go to Complete an IHCP
Provider Packet on this site and select the link
associated with your provider type.
- Select the IHCP provider packet indicated for your provider
classification and carefully review the instructions.
- Indicate "Revalidate Enrollment" in field 1 on
Schedule A, under Type of Request. Complete all
other fields in the packet, attach the required documentation, and
mail the packet to the address indicated.
- Revalidation requires providers to complete all applicable
information fields. It is not an update for which only additions,
deletions, or changes are required.
- Group providers do not need to submit new rendering provider
packets during revalidation (disregard the IHCP Rendering
Provider Enrollment and Profile Maintenance Packet at the end
of the group provider packet). To revalidate the rendering
providers linked to the group's service location at the time of
revalidation, submit a list of those rendering providers, including
the information outlined in the instructions, as an attachment to
the group packet.
- Providers are encouraged to review the
IHCP Provider Enrollment Type and Specialty
Matrix to determine supporting documentation
requirements based on provider type.
- Providers are encouraged to review the
IHCP Provider Enrollment Risk Category and Application Fee
Matrix to determine the screening criteria that apply to
their provider specialty during revalidation and to determine
whether an application fee is required. Providers subject to an
application fee are required to pay the fee at the time of
Revalidation requirements do not apply to practitioners
enrolling only as ordering, prescribing, or referring (OPR)
providers. See the Ordering,
Prescribing or Referring Providers page on this site for
more details about OPR providers.
Revalidation of enrollment is not the same as recertification of
enrollment credentials. See
Recertify Provider Enrollment Licenses and Other
Certifications on this site for details about the
For more information about provider enrollment revalidation, see
the Provider Enrollment
provider reference module.